EC and Depression

By Marjie O'Connor

One of the things that oncologist don't tell you about EC – or any kind of cancer, for that matter – is that many patients and caregivers develop depression while going through treatment – or, oddly enough, even after everything looks like it's going to be okay. One of the recognized causes of depression is extraordinary physical and emotional stress, which triggers all kinds of chemical reactions in the brain. Some of those chemicals regulate mood, among other things.

These chemical reactions are typical of the "fight or flight" reflex that is one of the most basic functions of all brains, from humans to earthworms. But when you're already fighting as hard as you can, and there is no way you can flee from the problem, the brain eventually can have its own little meltdown. Innumerable studies have proven the link between prolonged stress and physical illness. The body's cells, which are in overdrive during crisis, eventually just get worn down. That's true of brain cells, too.

As a result, depression is often triggered by some kind of trauma – or any kind of cancer, for that matter – is that many patients and caregivers develop depression while going through treat the loss of a loved one or maybe a temporary or permanent disability resulting from an accident. It can also result from burnout on the job or misfortune's uncanny tendency to dump multiple crises on one person at one time.

Depression also can result from an inborn inability of the brain to maintain enough serotonin in the system to keep everything on an even keel. That's no more of an "emotional problem" than inherited tendencies toward diabetes or heart disease. Yet many people perceive it as a weakness of some kind, so they either deny that they are depressed or expect themselves or someone else to snap out of it. No one expects a diabetic to snap out of diabetes, but the two conditions are similar: chemical imbalances that screw up everything else.

The really lousy thing about depression is that it is not easily diagnosed. There are no blood tests, x-rays, or MRIs that lead to an "Ah-ha!" moment. Its symptoms are very easily confused with so many other things, especially when the person is already sick with cancer. Here are some symptoms I pulled off the Website of Wyeth, the company that makes the antidepressant Effexor:

• Not involved with family and friends the way you used to be?

• Low on energy?

• Not motivated to do the things you once looked forward to doing?

• Not feeling as good as you used to?

Well, hello-0-0! You just went through chemo, radiation and/or surgery! Of course you don't feel as good as you used to! If you're spending every moment either taking care of a cancer patient or worrying about him or her, no wonder you are exhausted and not as involved with family and friends anymore!

In my personal experience, observation and research, though, the secret to telling the difference between depression and whatever else may be going on include additional symptoms:

• Irritability or anger. I'm not talking about occasional flares of "Why is this happening to me?" I mean regular, uncharacteristic outbursts such as "Why can't those grandchildren of ours play quietly?" or "That pharmacist must be an idiot if he can't fill a prescription any faster than this."

• Changes in personality. The formerly upbeat, enthusiastic person becomes quiet and withdrawn.

• A generally negative outlook. "It's no use. Why even try?"

• Overall apathy. A former action-flick addict says, "I don't care what movie we see. Whatever you decide is fine."

• Difficulty concentrating. This includes short-term memory problems such as having to re-read the same page in a book over and over again.

In short, the person is just not himself or herself.

If this new behavior continues for more than a couple of weeks, it's time to talk to the doctor about it. We're perfectly willing to get help with the physical pain associated with cancer, but we're so reluctant to deal with the mental and emotional pain.

Why on earth would you want to suffer any more than you already have, especially when it is so unnecessary? About 80% of people respond to the many medications that are available, although it takes an average of three or four tries to hit the right med or combo of meds. But help is out there, so get it!